The painful arc syndrome. Clinical classification as a guide to management

Abstract

Ninety-seven patients suffering from painful arc syndrome ofthe shoulder were studied. Local anaesthetic and radiographic contrast investigations were carried out. One-third of the patients had lesions in the posterior part of the rotator cuff which resolved after injections of local anaesthetic and steroid. One-third had anterior lesions in the subscapularis tendon: almost all resolved under the same regime but two required division of the coraco-acromial ligament. The remaining third had lesions of the supraspinatus tendon, usually associated with degeneration of the acromio-clavicular joint: most of these failed to gain relief from the local anaesthetic and steroid. Twenty-two operations were performed either by a transacromial or by a deltoid splitting approach. Excision of the outer end of the clavicle and division of the coraco-acromial ligament abolished the pain in most cases.

Alterations in Shoulder Kinematics and Associated Muscle Activity in People With Symptoms of Shoulder Impingement

“…2 Furthermore, although the supraspinatus tendon insertion into the humerus has been reported to be the most commonly affected, any or all of the tendons of the rotator cuff as well as the long head of the biceps muscle can be involved in impingement syndromes. 33 No attempt was made in this investigation to classify subjects as having various categories of impingement. Different impingement sites may relate to unique kinematic abnormalities, making it more difficult to ascertain overall group differences between subjects with shoulder impingement and subjects without shoulder impairment.…”

“…The experimental group was limited to people who had (1) a history of shoulder pain of greater than 1 week in duration, localized to the proximal anterolateral shoulder region, (2) a positive impingement sign, 2,32 a painful arc of movement (60°-120°), 33 or tenderness to palpation in the region of the greater tuberosity, acromion, or rotator cuff tendons, and (3) shoulder coronal-plane abduction of at least 130 degrees relative to the trunk. Subjects were excluded from the experimental group if any of the following were found during an examination: (1) reproduction of symptoms during a cervical screening examination (active and resisted range of motion [ROM], overpressure, quadrant test), 34 (2) abnormal results on thoracic outlet tests (Allen, Adson, Halstead), 35 (3) numbness or tingling in the upper extremity, or (4) a history of onset of symptoms due to traumatic injury, glenohumeral or acromioclavicular (AC) joint dislocation, or surgery on the shoulder.…”

Isokinetic clinical assessment of rotator cuff strength in subacromial shoulder impingement

“…Hawkins-Kennedy (Hawkins & Kennedy, 1980) and/or Neer (Neer, 1983) must be positive along with two of the following: external rotation resistance test (Michener et al, 2009),tendon palpation (N. Hanchard et al, 2004), horizontal (cross-body) adduction (Park et al, 2005), painful arc (Kessel & Watson, 1977), drop arm test (Park et al, 2005), Yergason test (Dalton, 1989), Speed test (Dalton, 1989;Park et al, 2005) • 'catching' or aching pain without appreciable joint stiffness (N. C. A. Hanchard & Handoll, 2008) • a painful arc elicited with pain easing on lowering the arm (N. Hanchard et al, 2004) • pain localized to the anterior or antero-lateral-superior shoulder (J. S. Lewis et al, 2001) • insidious onset of symptoms with a possible history of gradual progression over time but without history of trauma (Bigliani & Levine, 1997) • xray or ultrasound scans revealing osteophytes within the subacromial region, calcification of tendons or large rotator cuff tears .…”

Calsified Tendinitis with Intratendinous Mass Apperance at Shoulder Sonography. Case Report: US and MRI Findings

“…Subakut ve kronik evrede ağrı ve hassasiyet ön plandadır ve glenohumeral eklem hareketinde kısıtlılığa neden olur. 10 İntratendinöz kalsifikasyon depoziti bursa içine rüptüre olursa bursit ve şiddetli ağrı kaçınıl-mazdır. 11 Nadiren depozit glenohumeral eklem aralığına da rüptüre olabilir.…”